75R11703 PB-F
By Berlanga, Maxey H.B. No. 2846
Substitute the following for H.B. No. 2846:
By Berlanga C.S.H.B. No. 2846
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the provision of health care services by advanced
1-3 practice nurses and physician assistants in collaborative practice
1-4 with physicians.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Section 3.06(d)(5)(D), Medical Practice Act
1-7 (Article 4495b, Vernon's Texas Civil Statutes), is amended to read
1-8 as follows:
1-9 (D) Physician supervision shall be adequate if a
1-10 delegating physician:
1-11 (i) is responsible for the formulation or
1-12 approval of such physician's orders, standing medical orders,
1-13 standing delegation orders, or other orders or protocols and
1-14 periodically reviews such orders and the services provided patients
1-15 under such orders;
1-16 (ii) is on site to provide medical
1-17 direction and consultation at least once every 10 business days
1-18 during which the advanced practice nurse or physician assistant is
1-19 on site providing care [a week to provide medical direction and
1-20 consultation];
1-21 (iii) receives a daily status report from
1-22 the advanced practice nurse [registered nurse] or physician
1-23 assistant on any problems or complications encountered; and
1-24 (iv) is available through direct
2-1 telecommunication for consultation, assistance with medical
2-2 emergencies, or patient referral.
2-3 SECTION 2. Section 3.06(d)(5)(E), Medical Practice Act
2-4 (Article 4495b, Vernon's Texas Civil Statutes), is amended by
2-5 adding Subparagraph (vii) to read as follows:
2-6 (vii) "Advanced practice nurse" has the
2-7 meaning assigned to that term by Section 8, Article 4514, Revised
2-8 Statutes.
2-9 SECTION 3. Section 3.06(d)(6)(G)(iii), Medical Practice Act
2-10 (Article 4495b, Vernon's Texas Civil Statutes), is amended to read
2-11 as follows:
2-12 (iii) "Primary practice site" means:
2-13 (a) the practice location
2-14 where the physician spends the majority of the physician's time;
2-15 (b) a licensed hospital, a
2-16 licensed long-term care facility, and a licensed adult care center
2-17 where both the physician and the physician assistant or advanced
2-18 nurse practitioner are authorized to practice, a clinic operated by
2-19 or for the benefit of a public school district for the purpose of
2-20 providing care to the students of that district and the siblings of
2-21 those students, or an established patient's residence; or
2-22 (c) where the physician is
2-23 physically present with the physician assistant or advanced nurse
2-24 practitioner.
2-25 SECTION 4. Section 14, Texas Health Maintenance Organization
2-26 Act (Article 20A.14, Vernon's Texas Insurance Code), is amended by
2-27 adding Subsections (i) and (j) to read as follows:
3-1 (i) If an advanced practice nurse or physician assistant is
3-2 authorized to provide care under Section 3.06(d)(5) or (6), Medical
3-3 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), by a
3-4 physician participating in a health maintenance organization's
3-5 provider network, the health maintenance organization may not
3-6 refuse a request made by the physician and physician assistant or
3-7 advanced practice nurse to have the physician assistant or advanced
3-8 practice nurse identified as a provider in the provider network
3-9 unless the physician assistant or advanced practice nurse fails to
3-10 meet the quality of care standards previously established by the
3-11 health maintenance organization for participation in the network by
3-12 advanced practice nurses and physician assistants.
3-13 (j) A health maintenance organization may not refuse to
3-14 contract with an advanced practice nurse or physician assistant to
3-15 be included in the organization's provider network, refuse to
3-16 reimburse the advanced practice nurse or physician assistant for
3-17 covered services, or otherwise discriminate against the advanced
3-18 practice nurse or physician assistant because the advanced practice
3-19 nurse or physician assistant is not identified under Section 3,
3-20 Article 21.52, Insurance Code.
3-21 SECTION 5. Subchapter G, Chapter 3, Insurance Code, is
3-22 amended by adding Article 3.70-3C to read as follows:
3-23 Art. 3.70-3C. USE OF ADVANCED PRACTICE NURSES AND PHYSICIAN
3-24 ASSISTANTS BY PREFERRED PROVIDER PLANS
3-25 Sec. 1. In this article:
3-26 (1) "Preferred provider" means a physician, advanced
3-27 practice nurse, physician assistant, or other health care provider,
4-1 or an organization of physicians or health care providers, who
4-2 contracts with an insurer to provide medical care or health care to
4-3 insureds covered by a health insurance policy, certificate, or
4-4 contract.
4-5 (2) "Preferred provider benefit plan" means a benefit
4-6 plan through which an insurer provides, through its health
4-7 insurance policy, for the payment of a level of coverage that is
4-8 different from the basic level of coverage provided by the health
4-9 insurance policy if the insured uses a preferred provider.
4-10 Sec. 2. If an advanced practice nurse or physician assistant
4-11 is authorized to provide care under Section 3.06(d)(5) or (6),
4-12 Medical Practice Act (Article 4495b, Vernon's Texas Civil
4-13 Statutes), by a physician participating as a preferred provider
4-14 under a preferred provider benefit plan, that plan may not refuse a
4-15 request made by the physician and physician assistant or advanced
4-16 practice nurse to have the physician assistant or advanced practice
4-17 nurse included as a preferred provider by the plan unless the
4-18 physician assistant or advanced practice nurse fails to meet the
4-19 quality of care standards previously established by the preferred
4-20 provider benefit plan for participation in the plan by advanced
4-21 practice nurses and physician assistants.
4-22 Sec. 3. A preferred provider benefit plan may not refuse to
4-23 contract with an advanced practice nurse or physician assistant to
4-24 be included in the plan's provider network, refuse to reimburse the
4-25 advanced practice nurse or physician assistant for covered
4-26 services, or otherwise discriminate against the advanced practice
4-27 nurse or physician assistant because the advanced practice nurse or
5-1 physician assistant is not identified under Section 3, Article
5-2 21.52, Insurance Code.
5-3 SECTION 6. Section 2(B), Chapter 397, Acts of the 54th
5-4 Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
5-5 Insurance Code), is amended to read as follows:
5-6 (B) No policy of accident and sickness insurance shall make
5-7 benefits contingent upon treatment or examination by a particular
5-8 practitioner or by particular practitioners of the healing arts
5-9 hereinafter designated unless such policy contains a provision
5-10 designating the practitioner or practitioners who will be
5-11 recognized by the insurer and those who will not be recognized by
5-12 the insurer. Such provision may be located in the "Exceptions" or
5-13 "Exceptions and Reductions" provisions, or elsewhere in the policy,
5-14 or by endorsement attached to the policy, at the insurer's option.
5-15 In designating the practitioners who will and will not be
5-16 recognized, such provision shall use the following terms: Doctor
5-17 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
5-18 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
5-19 Audiologist, Licensed Speech-language Pathologist, Doctor in
5-20 Psychology, Licensed Master Social Worker--Advanced Clinical
5-21 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
5-22 Licensed Marriage and Family Therapist, Licensed Chemical
5-23 Dependency Counselor, Licensed Hearing Aid Fitter and Dispenser,
5-24 Advanced Practice Nurse, Physician Assistant, and Licensed
5-25 Psychological Associate.
5-26 For purposes of this Act, such designations shall have the
5-27 following meanings:
6-1 Doctor of Medicine: One licensed by the Texas State Board of
6-2 Medical Examiners on the basis of the degree "Doctor of Medicine";
6-3 Doctor of Osteopathy: One licensed by the Texas State Board
6-4 of Medical Examiners on the basis of the degree of "Doctor of
6-5 Osteopathy";
6-6 Doctor of Dentistry: One licensed by the State Board of
6-7 Dental Examiners;
6-8 Doctor of Chiropractic: One licensed by the Texas Board of
6-9 Chiropractic Examiners;
6-10 Doctor of Optometry: One licensed by the Texas Optometry
6-11 Board;
6-12 Doctor of Podiatry: One licensed by the Texas State Board of
6-13 Podiatric Medical Examiners;
6-14 Licensed Audiologist: One with a master's or doctorate
6-15 degree in audiology from an accredited college or university and
6-16 who is licensed as an audiologist by the State Board [Committee] of
6-17 Examiners for Speech-Language Pathology and Audiology;
6-18 Licensed Speech-language Pathologist: One with a master's or
6-19 doctorate degree in speech pathology or speech-language pathology
6-20 from an accredited college or university and who is licensed as a
6-21 speech-language pathologist by the State Board [Committee] of
6-22 Examiners for Speech-Language Pathology and Audiology;
6-23 Doctor in Psychology: One licensed by the Texas State Board
6-24 of Examiners of Psychologists and certified as a Health Service
6-25 Provider;
6-26 Licensed Master Social Worker--Advanced Clinical
6-27 Practitioner: One licensed by the Texas State Board of Social
7-1 Worker Examiners as a Licensed Master Social Worker with the order
7-2 of recognition of Advanced Clinical Practitioner;
7-3 Licensed Dietitian: One licensed by the Texas State Board of
7-4 Examiners of Dietitians;
7-5 Licensed Professional Counselor: One licensed by the Texas
7-6 State Board of Examiners of Professional Counselors;
7-7 Licensed Marriage and Family Therapist: One licensed by the
7-8 Texas State Board of Examiners of Marriage and Family Therapists;
7-9 Licensed Chemical Dependency Counselor: One licensed by the
7-10 Texas Commission on Alcohol and Drug Abuse;
7-11 Licensed Hearing Aid Fitter and Dispenser: One licensed by
7-12 the Texas Committee [Board] of Examiners in the Fitting and
7-13 Dispensing of Hearing Instruments [Aids];
7-14 Advanced Practice Nurse: One licensed by the Board of Nurse
7-15 Examiners as a registered nurse and recognized by that board as an
7-16 advanced practice nurse;
7-17 Physician Assistant: One licensed by the Texas State Board
7-18 of Physician Assistant Examiners; and
7-19 Licensed Psychological Associate: One licensed by the Texas
7-20 State Board of Examiners of Psychologists and practicing under the
7-21 supervision of a licensed psychologist.
7-22 SECTION 7. Sections 4-6 of this Act apply only to an
7-23 insurance policy or evidence of coverage that is delivered, issued
7-24 for delivery, or renewed on or after January 1, 1998. A policy or
7-25 evidence of coverage that is delivered, issued for delivery, or
7-26 renewed before January 1, 1998, is governed by the law as it
7-27 existed immediately before the effective date of this Act, and that
8-1 law is continued in effect for this purpose.
8-2 SECTION 8. This Act takes effect September 1, 1997.
8-3 SECTION 9. The importance of this legislation and the
8-4 crowded condition of the calendars in both houses create an
8-5 emergency and an imperative public necessity that the
8-6 constitutional rule requiring bills to be read on three several
8-7 days in each house be suspended, and this rule is hereby suspended.